Localised odontogenic infections

An odontogenic infection is considered to be localised if it causes dental pain without facial swelling or systemic features. Localised odontogenic infections can involve periapical, pericoronal or periodontal abscesses—see Anatomical location of localised odontogenic infections and associated conditions for their anatomical location. Signs of abscess include visible pus, a localised swelling on the gum or fluctuant tissue. However, dental pain may be the only sign of a periapical abscess.

1. pericoronal infection

2. pericoronal abscess

3. gingivitis

4. periodontitis (bone loss)

5. periodontal abscess

6. periapical inflammation (apical periodontitis) or abscess

The key to successful management of localised odontogenic infection is dental treatment to drain pus and address the source of infection—see Dental treatment options for acute localised odontogenic infections for treatment options. Antibiotic therapy is not required because dental treatment removes the source of infection and bacteraemia caused by treatment resolves rapidly.

However, if an infected tooth breaks during an extraction and there is a delay in removing residual root or bone fragments, antibiotic therapy is indicated—see here for a suggested antibiotic regimen. If the tooth is not infected, antibiotic therapy is not required.

Patients with localised odontogenic infection may present to a medical practitioner; promptly refer the patient to a dentist for treatment. If dental treatment is not likely to be received within 24 hours, start antibiotic therapy (see here for an appropriate antibiotic regimen). However, antibiotic therapy is not a substitute for dental treatment so ensure the patient sees a dentist. Offer systemic analgesics for the treatment of dental pain (see Choice of analgesic for acute dental pain). For pericoronal infections, irrigate the area with sterile saline solution, and recommend rinsing with warm saline or chlorhexidine mouthwash until dental treatment can take place.